【作者】 陈明；

【导师】 张钟爱；

【作者基本信息】 南京中医药大学 ， 中西医结合， 2007， 硕士

【摘要】 目的：高血压病是一种最常见的心血管疾病，严重危害着人类的健康。大量临床实践证明，中西医结合综合治疗高血压病可以取长补短，提高疗效，而且中医辨证分型治疗本病，符合治疗个体化的原则，疗效优势更明显。而高血压病患者常伴发糖尿病及高脂血症，糖尿病及高脂血症也是危害人类健康的常见疾病。本课题拟分别观察高血压病患者的血糖、血脂及胰岛素敏感性指数，并按照辨证分型标准进行严格辨证，以探讨高血压病各证候与上述三方面指标的关系，并进行统计分析，以期对高血压病中医各证候做出客观化诊断，从而更好地指导临床规范化治疗，并可尽早预测不同证型高血压病最可能的伴发疾病，尽早预防与治疗。方法：对80名入选患者参照《中药新药临床研究指导原则》关于“治疗高血压病的临床研究指导原则”所确定的辨证标准，将入选患者辨证分为肝火亢盛证、阴虚阳亢证、痰湿壅盛证和阴阳两虚证四型。每组患者均化验血脂、空腹血糖、空腹胰岛素及糖化血红蛋白，并计算胰岛素敏感指数，分别进行血脂、空腹血糖、空腹胰岛素、胰岛素敏感指数及糖化血红蛋白的统计。结果：(1)高血压病不同证型血脂水平比较：高血压病痰湿壅盛组与正常对照组的TC及TG比较有显著差异(P＜0.05)。高血压病痰湿壅盛组与肝火亢盛、阴虚阳亢、阴阳两虚三组相比，TG有显著差异(P＜0.05)。(2)高血压病不同证型空腹血糖、空腹胰岛素及胰岛素敏感指数水平比较：①就FBG而言，高血压病肝火亢盛、阴虚阳亢、痰湿壅盛三组与正常对照组比较有显著意义(P＜0.05)。②就F-INS而言，高血压病肝火亢盛组显著高于正常对照组及其他三组(P＜0.05)。③而对于ISI而言，高血压病各组与正常对照组比较均有显著意义(P＜0.05)。高血压病各证型之间胰岛素敏感性排列顺序为阴阳两虚＞阴虚阳亢＞痰湿壅盛＞肝火亢盛。(3)高血压病不同证型糖化血红蛋白水平比较：高血压病组各证型与正常对照组之间的HbA1c比较无统计学差异(P＞0.05)。结论：本研究资料显示，胰岛素抵抗存在于高血压病各证型之中，IR及HI以肝火亢盛型为盛，ISI的顺序依次为阴阳两虚＞阴虚阳亢＞痰湿壅盛＞肝火亢盛。而在高血压病各辨证分型中，TG升高主要存在于痰湿壅盛型中。故血脂及胰岛素敏感指数可以作为高血压病中医辨证的参考指标。更多还原

【Abstract】 Objective: Essential hypertension(EH) is a sort of cardiovascular disease, it does great harm to people’s health. Many clinical practices prove that Chinese medicine treatment for EH has its prevalence. Patient of EH often accompany with diabetes and hyperlipoidemia, which is also the common disease to harm human’s healthy. The purpose of this subject is to investigate the relationship among syndrome of Eh in TCM, blood glucose, blood fat and sensitivity of insulin, in order to direct clinical treatment better and predict the most possible accompany disease earlier.Methods: 80 patients of EH were selected and classified into 4 types according to syndrome differentiation classified in TCM: the Liver-Fire exuberant syndrome, the phlegm-dampness abundant syndrome, Yin-deficiency and Yang-hyperactivity syndrome and the Yin-Yang dual deficiency syndrome. Statistics has been done in the level of blood fat, FBG, F-INS, ISI and HbAlc. All the data above were compared among the four syndromes.Result: (1) Comparison of the four syndromes’ parameters of blood fat: The phlegm-dampness abundant syndrome’s TC&TG were higher than the normal group. the difference among them is significant (P＜0.05). The phlegm-dampness abundant syndrome’s TG were higher than the other three syndrome (P＜0.05).(2) Comparison of the four syndromes’ parameters of FBG, F-INS and ISI:①The FBG, which is of the Liver-Fire exuberant syndrome, the phlegm-dampness abundant syndrome, Yin-deficiency and Yang-hyperactivity syndrome, is higher than the normal group(P＜0.05).②The F-INS, which is of the Liver-Fire exuberant syndrome, is higher than the other three syndrome and the normal group(P＜0.05). Compared to the normal group, The ISI, which is of the four types of EH, is significant(P＜0.05), the sequence of sensitivity of insulin among the four types of EH is the Yin-Yang dual deficiency syndrome＞Yin-deficiency and Yang-hyperactivity syndrome＞the phlegm-dampness abundant syndrome＞the Liver-Fire exuberant syndrome.(3) Comparison of the four syndromes’ parameters of HbAlc: there’s no statistics difference between the four types of EH and the normal group (P＞0.05).Conclusion: The data shows that insulin resistance resides in the each type of EH. IR&HI are main contained in the Liver-Fire exuberant syndrome, among the syndrome of EH, the advance of TG is main contained in the phlegm-dampness abundant syndrome. The blood fat and ISI can become the refindex of syndrome differentiation clssified in TCM.更多还原